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Redefining Dead

It's a couple weeks old, but here's a very interesting article on the current debate among medical ethicists of when someone should be considered dead for the purpose of organ donation:

Truog is one of a handful of vocal critics who believe the medical community is misleading the public -- and deluding itself -- with an arbitrary definition of death. The debate, which is being fought largely in academic journals, has important implications for the modern enterprise of transplantation, which prolonged the life of more than 28,000 Americans last year. Truog and other critics believe that changing the rules -- and the bright-line concept of death that underlies them -- could mean saving more of the 6,500 Americans who die every year waiting for an organ.

...This debate exposes a jarring collision: On the one hand, there is the view that life and death are clear categories; on the other, there is the view that death, like life, is a process. Common sense -- and the transplant community -- suggest that death is a clear category. Truog and other critics suggest that this is to ignore reality.

"They think, 'We can't remove these organs unless we decide that you're dead,"' says Truog, "so the project becomes gerrymandering the criteria we use to call people dead."

Many people assume that we have good criteria for determining when someone is dead, but we don't and never have. I wrote about this several years ago, during the Ted Williams cryonics controversy:

There's no point at which we can objectively and scientifically say, "now the patient is dead -- there is no return from this state," because as we understand more about human physiology, and experience more instances of extreme conditions of human experiences, we discover that a condition we once thought was beyond hope can routinely be recovered to a full and vibrant existence.

Death is thus not an absolute, but a relative state, and appropriate medical treatment is a function of current medical knowledge and available resources. What constituted more-than-sufficient grounds for declaration of death in the past might today mean the use of heroic, or even routine, medical procedures for resuscitation. Even today, someone who suffers a massive cardiac infarction in the remote jungles of Bolivia might be declared dead, because no means is readily available to treat him, whereas the same patient a couple blocks from Cedars-Sinai in Beverly Hills might be transported to the cardiac intensive-care unit, and live many years more.

I find it heartening that this debate is finally occurring, rather than the medical community dogmatically keeping its head planted firmly in the sand. Because it lends further credence to the concept of suspension (cryonic or otherwise), and clarifies whether or not cryonics patients are alive or dead. The only useful definition of death is information death (e.g., cremation, or complete deterioration of the remains). As long as the structure remains in place, the patient hasn't died--he's just extremely ill, to the point at which he's non-functional and unable to be revived with current technology.

In fact, given that this debate is about organ donation, it's quite applicable to cryonics. In a very real sense, cryonics is the ultimate organ donation (and in fact it's treated that way under some state's laws). You are effectively donating your whole body (or just your head, in the case of a neurosuspension) to your future self.

But it will continue to tie the legal system up in knots, and declaring cryonics patients to be alive would be a problem under the current cryonics protocols, because unless one is wealthy, the procedure is paid for with a life insurance policy. If you're not declared dead, then you don't get the money to preserve yourself. But if you don't preserve yourself, you'll eventually be clearly dead by any criteria, as your body decomposes. At which point the policy would pay off, far too late to preserve your life.

And of course, if a cryonics patient isn't considered dead, then the heirs won't get any inheritance at all. Cryonics patients already have enough fights with relatives over the amount that they'll inherit due to the cost of the suspension. Keeping them legally alive will only make this situation worse. We really need to come up with some creative new laws to deal with this, but I suspect it's not a very high priority among legislatures who, when they deal with cryonics at all, generally instead of facilitating it, attempt to outlaw it or regulate it out of existence. And that's not likely to change any time soon, regardless of the state of the debate in the medical ethics community.


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Karl Hallowell wrote:

Another problem here is that any means that successfully prolongs the viability of organs also can prolong determination of death. So it's not a simple matter of hooking up a dying person and keeping their organs alive after death.

Bob Hawkins wrote:

As Miracle Max put it in "The Princess Bride," "Mostly dead is partly alive!"

Jonathan wrote:

Technical and medical issues aside, the question of who gets to determine that someone is dead is hugely important. There are conflicts of interest that "medical ethicists," who have their own conflict because many of their arguments rely on a presumption of the authority of experts such as themselves to make decisions for other people, tend to ignore. The determination of a person's death should not be made by people who benefit, or whose colleagues or employers benefit, from that death. Physicians and hospitals may benefit from the availability of transplantable organs. Hospitals may benefit by freeing up resources that could be used for other patients. Insurers may benefit because their liability for medical payments ends. Under socialized medicine, the government benefits because it is both the insurer and runs the organ-transplantation system. These are reasons to leave as much authority about death decisions as possible in the hands of the patient and his family.

K wrote:

Sadly, this issue will forever be defined for me by the "Organ Donor" scenes from Monty Python's "Meaning of Life".

I'm surprised nobody mentioned the obvious quote from H. P. Lovecraft: "That is not dead which can eternal lie..."

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This page contains a single entry by Rand Simberg published on March 21, 2008 12:29 PM.

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